MEDICARE: DR. DEAN E BRIGHT D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	131	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	59943	OTHER	AR	ARKANSAS BLUE CROSS BLUE
3	14707000000	OTHER	AR	QUAL CHOICE

General Provider Information

NPI Number	:	1770581357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN E BRIGHT D.P.M.

Provider Business Mailing Address
First Line	:	1670 W SUNSET AVE
Second Line	:	SUITE A
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5136
Country	:	US
Telephone Number	:	479-750-3131
Fax Number	:	479-750-9631

Provider Business Practice Location Address
First Line	:	1670 W SUNSET AVE
Second Line	:	SUITE A
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5136
Country	:	US
Telephone Number	:	479-750-3131
Fax Number	:	479-750-9631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/11/2011

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